Status of source became known - Is my PEP no longer enough?

[spirax88]

I made a huge error and had unprotected receptive intercourse with a man who said he was negative when under the influence of alcohol. He did not ejaculate inside me though I know it is still high risk activity. This is not normal for me. It didn't feel right and I went to see the doctor the next day and started PEP (Truvada only) approximately 19 hours after exposure.

I received a text message around 5 days later from the guy saying that he was showing symptoms of acute infection and sure enough he tested positive a few days later. This has stressed me to no end. I understand this will mean he had a high viral load and therefore will be more infectious. I contacted my doctor after doing some research to see if I could have a third drug added to my regimen but it was over a week at this point so I wasnt able to. I am really disappointed I wasnt started on 3 drugs to begin with. The doctor did try to assure me that 2 drugs is still thought to be very effective and it is a good sign that I started the medication within 24 hours. I am not sure if she is just trying to make me feel better, from what I have been able to read, most people get 3 drugs for far less risky exposure. Feeling like the odds are against me at this point and highly concerned my PEP regime is insufficient.

Anything suggestions on things I can do at this point or advice would be appreciated. I am quite frightened. Oh genuinely thanks for all the advice and time.

[Ann]

Spirax,

Take a deep breath and calm down. The doctor wasn't blowing smoke up your ass - she's absolutely right in everything she told you.

You have quite a bit in your favour.

He didn't ejaculate in you.

You started PEP well within 24 hours - 72 is the maximum, but 24 is best.

Truvada on its own IS an approved PEP regimen, and it wouldn't be if it didn't work on its own.

It's also not necessarily true that he had a really high viral load. Not everyone does at that point. It can take up to ten days for it to even show up on viral load tests, and four or so weeks before it gets really high. Most people (who actually experience symptoms, not everyone does) will start getting them within two to three weeks, and the average time to seroconversion is only 22 days.

What's important now is that you make sure you take your Truvada every day, and try to take it around the same time everyday to maintain optimal levels of it in your body.

You will need to test at six weeks after your last dose of PEP, and if that is negative (which is what I fully expect), you will have to confirm that at the three month post-PEP point.

I really do expect you to come out of this ok. You've got everything in your favour.

But PLEASE, please learn from this mistake!

Ann

[Ann]

I only just realised I wasnt clear in my first post Ann. Sorry about that and thanks for the response. It was anal receptive intercourse (I realised you could have assumed otherwise). Do you still think the odds are in my favour?

Spirax, I've quoted your post above so I can delete it. You only get three free posts here before you have to take out a subscription and I didn't want you to use one up on this clarification.

I did understand that you were the receptive partner.

And I do think you have an excellent chance of ultimately testing hiv negative. You have everything going in your favour.

I already wrote this post out once, but we're having some sort of glitch in the software at the moment and it won't let me use more than one instance of code. I attempted to link you to some lessons you may find useful, but I used code instead of just posting the bare links. I'll try again....

If you want to read about the meds you're on, go to the treatments page: http://www.aidsmeds.com/list.shtml

You're not likely to experience any side-effects on Truvada, but you may experience some discomfort in the form of excess farting and it's slightly possible you may feel fatigue. Check out these two side-effect lessons if either of these things become problematic:

http://www.aidsmeds.com/articles/Fatigue_7533.shtml

http://www.aidsmeds.com/articles/Nausea_7486.shtml

I'm going to go ahead and post this now while you're still online, but hang on because I have more to say. I'm going to post this and start writing again.

You have two more free posts left, please use them wisely.

Ann

[Ann]

Spirax,

Here's some additional information/thoughts that I lost when I got an error message when I initially tried to respond to you a second time.

Regarding being on Truvada alone, the only possible problem I can foresee is if you weren't given a rapid hiv test before you were prescribed PEP. If you weren't and there's a chance you were already poz, being on a two drug regimen can lead to drug resistance.

I trust you were given a rapid test; the health system of country you're in has a good track record of following proper PEP protocol. If you were tested, don't use up a post to tell me, I'll understand that you were tested prior to being prescribed PEP.

People who are poz and on meds must be on at least three meds, from at least two different classes of meds. The two drugs in Truvada are from one class and if you were poz before this unprotected incident occurred, you would need a third drug from a different class to avoid resistance.

If you were given a rapid test before initiating PEP, then you don't need to worry about resistance issues.

Ack. I said all this much more eloquently and succinctly the first time around. Sorry.

Again, you have two free posts left (unless you've posted again while I've been writing this) so please use them wisely. A subscription doesn't cost much though, and all you need is a pay-pal account.

Good luck. I really, really do expect you to come out of this hiv negative, provided you make sure you take your Truvada every day, and take it as close to 24 hours apart as humanly possible. An hour either way won't be a problem, but try to not let it stretch out much longer than that. You want to keep the optimal level of drugs in your body.

Ann

[spirax88]

Thanks for the info Ann. Yes there was a baseline test so all good there. He contacted me today to tell me that he had a very high viral load at the time we met (and that another partner he had sex with days before is now HIV+ too (this guy didn't take pep apparently). This is an aweful situation. He was clearly very infectious at the time we met. I am so frightened and I am worried that the PEP may not be adequate to cover his high viral load. Is there any research on this that you know of? I thought there was a chance that even without pep there would not be transmission but considering this other partner is now positive I am not sure of that

[Ann]

Spirax,

Funny enough, I was just now reading the PEP guidelines from your country in order to give an accurate reply to another poster here. The issue of a two-drug regimen vs. a three-drug regimen is addressed in the guidelines:

"There is no direct evidence to support the greater or lesser efficacy of three over two drug preventive regimens."

Trust me hun, your doctor doesn't want you to end up poz any more than you (or we) do. Truvada is a very effective two-drug combo for the purpose of PEP, as well as PrEP.

PrEP is taking hiv meds as a pre-exposure prophylaxis and Truvada has been approved for this use. It must be taken every day, not just before a night out.

I thought there was a chance that even without pep there would not be transmission but considering this other partner is now positive I am not sure of that

What you thought prior to this experience was true. Exposure does NOT guarantee infection. Hiv is actually a finicky little beggar and the environment and circumstances need to be just right in order for transmission to take place. And remember, he didn't ejaculate in you.

You started PEP in a timely manner. Keep taking it every day, as close to 24 hours apart as humanly possible, and there is no reason to think you won't come out of this hiv negative.

Hang in there, ok?

Ann

[spirax88]

Hi guys, thought I would give an update and hear your thoughts. So it is now 9.5 weeks post exposure (almost 6 weeks post PEP) and I went for a rapid HIV test which has come back negative or non-reactive. I didnt do so well on my exams recently, this was all I have been able to think about. How encouraging is a negative test at this point remembering I did take a full course of PEP (started 19 hours after exposure with excellent adherence)? I was hoping a negative test would give me some relief but I still feel as wound up and anxious as before, currently requiring sleeping medication from time to time.

By the way, thank you for your support on this forum. You all really are wonderful. Anns encouraging words provided me great comfort over the last 10 weeks or so.